A qualitative analysis of loss-related memories after cancer loss: a comparison of bereaved people with and without prolonged grief disorder

Investigation of the effectiveness of short-term grief-focused group intervention for 1st degree losses in earthquake

A considerable number of individuals who lost family members in the 2023 earthquake in Hatay province, Turkey, have been found to experience a range of psychosocial problems and disorders. In this randomised controlled trial, the efficacy of grief-focused group therapy was compared with that of a control group that did not receive any treatment. A total of 10 Turkish adults were randomly assigned to the group therapy group. The participants were evaluated at the outset of the study and at its conclusion in order to ascertain any changes in psychological resilience (Psychological Resilience Scale for Adults), grief symptoms (Grief Scale), and cognitive flexibility (Cognitive Flexibility Inventory). The results of the study are as follows: The results demonstrated that grief-focused group therapy was an effective intervention for reducing grief symptoms and enhancing psychological resilience and cognitive flexibility. A brief grief-focused group intervention has been demonstrated to be an efficacious intervention for earthquake survivors. The brief grief-focused group intervention proved more efficacious than the control condition in enhancing psychological resilience and cognitive flexibility, while concurrently attenuating grief symptoms, among adults who lost first-degree family members in the earthquake. Overall, the Grief Recovery Focused Group Therapy Program yielded a favourable impact on alpha, beta, and gamma scores in the experimental group, while exhibiting no discernible effect on delta and theta scores.

Experiences of Iranian people who lost a partner in road traffic collisions: A descriptive phenomenology

This study explores the experiences of Iranian bereaved spouses who lost partners in Road Traffic Collisions (RTCs) one to three years earlier. Seventeen participants were interviewed using purposive sampling. Three central themes emerged: (1) "The unfillable void," revealing the profound emptiness experienced by the bereaved, the factors that maintain this void, and the challenges in accepting human-induced deaths as fate. This leads to difficulties in finding meaning in the loss, resulting in anger and seeking revenge; (2) "The Iranian mourning," exploring cultural impacts such as Chehelom, alongside confronting loneliness that ensues after this period ends, and the cultural stigma faced by the bereaved; (3) "One's perspective on life," highlighting personal growth amid adversity. The study emphasizes the necessity for culturally sensitive support services and suggests psychological therapies addressing feelings of retaliation and fury. These insights offer valuable contributions to understanding bereavement in diverse cultural contexts, informing legislators and healthcare professionals.

Humor: A Grief Trigger and Also a Way to Manage or Live With Your Grief

In 2020-2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.

Letter Writing as a Clinical Tool in Grief Psychotherapy

The benefits of expressive writing have been explored since at least the 1980s. The effect of expressive bereavement-related writing has been studied primarily in college students, yielding inconclusive results. Nonetheless, recent effective, integrated psychotherapy protocols, targeting complicated and prolonged grief, include writing assignments, typically in the form of letters. The present paper explores how and why letter writing might be effective and meaningful as a therapeutic tool in the context of grief psychotherapy. It describes how working with letters, addressed to the deceased, might help facilitate self-disclosure, promote exposure to what is avoided, confront unfinished business, encourage continuing bonds, and help achieve a coherent narrative around experiences with the loss. As a therapeutic tool, letter writing has the potential to be helpful to many bereaved people, as it is a simple, effective, and meaningful way to access and work with relevant clinical material in the context of psychotherapy.

Life beyond Loss: A Retrospective Analysis of the Impact of Meaning of Life Therapy on the Grieving Process of Cancer Patients' Family Caregivers

Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.

A quasi-experimental trial of narrative reconstruction for prolonged grief disorder: Symptomatic improvement and enhanced memory integration

BACKGROUND

Prolonged grief disorder (PGD) was recently approved as a formal diagnosis in the DSM-5-TR. The implementation of bereavement interventions is frequently requested, but their effectiveness has been controversial. Narrative reconstruction (NR) is a time-limited integrative therapy, originally developed for the treatment of post-traumatic stress disorder (PTSD) and adapted for the treatment of PGD. NR consists of exposure to the loss memory, a detailed written reconstruction of the loss memory narrative, and an elaboration of the personal significance of that memory for the bereaved.

OBJECTIVES

In this study we evaluated the efficacy of NR for PGD.

METHOD

In this study, 33 participants with PGD were quasi-randomized-that is, assigned to an immediate (n = 20) or delayed (n = 13) 16-session NR intervention. PGD, intrusion, avoidance and depression symptoms, as well as levels of the loss memory integration, were assessed at pretreatment, post-treatment, and at a 3-month follow-up.

RESULTS

Mixed linear models showed significant intervention effects for PGD and intrusive symptomatology. Results also showed an increase in integration of the loss memory, and improvements remained stable for all outcomes at follow-up.

CONCLUSION

In this study we established NR as an effective intervention for PGD and call for further validation in future studies. Integrating this intervention into the routine care of people with PGD seems important and beneficial.

Moving forward with the loss of a loved one: treating PTSD following traumatic bereavement with cognitive therapy

Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD; Ehlers et al., 2005). The paper describes the core components of CT-PTSD for bereavement trauma with illustrative examples, and clarifies how the therapy differs from treating PTSD associated with trauma where there is no loss of a significant other. A core aim of the treatment is to help the patient to shift their focus from loss to what has not been lost, from a focus on their loved one being gone to considering how they may take their loved one forward in an abstract, meaningful way to achieve a sense of continuity in the present with what has been lost in the past. This is often achieved with imagery transformation, a significant component of the memory updating procedure in CT-PTSD for bereavement trauma. We also consider how to approach complexities, such as suicide trauma, loss of a loved one in a conflicted relationship, pregnancy loss and loss of life caused by the patient.

Key learning aims

To be able to apply Ehlers and Clark's (2000) cognitive model to PTSD arising from bereavement trauma.To recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life.To discover how to conduct imagery transformation for the memory updating procedure in CT-PTSD for loss trauma.

Coping strategies as a causal mediator of the effect of loss-related memory characteristics and negative loss-related appraisals on symptoms of PGD, PTSD and depression

BACKGROUND

Psychological models of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD) make predictions about the role of unhelpful coping strategies in maintaining difficulties by blocking self-correction of negative appraisals and memory integration following stressful life events like bereavement. However, few studies have tested these predictions directly.

METHOD

We used counterfactually based causal mediation to assess whether unhelpful coping strategies mediated the relationship between (1) loss-related memory characteristics and/or (2) negative grief-related appraisals and symptoms of PGD, PTSD and depression using a three-wave longitudinal sample (N = 275). Appraisals and memory characteristics were measured at time point 1, unhelpful coping strategies at T2, and symptom variables at T3. Additionally, multiple mediation analyses within a structural equation modelling (SEM) framework assessed which types of coping strategies differentially mediated symptoms of PGD, PTSD and depression.

RESULTS

Coping strategies mediated the relationship between negative appraisals and memory characteristics and symptoms of PGD, PTSD and depression after adjusting for demographics and loss characteristics. Sensitivity analyses suggested that these results were most robust for PGD, followed by PTSD and then depression. Multiple mediation analyses suggested that all four subscales (avoidance, proximity seeking, loss rumination and injustice rumination) individually mediated the effect of memory characteristics and appraisals on PGD.

CONCLUSIONS

These results suggest that core predictions of the cognitive model for PTSD and the cognitive behavioural model of PGD are useful in predicting symptoms of post-loss mental health problems in the first 12-18 months after loss. Targeting unhelpful coping strategies is likely to reduce symptoms of PGD, PTSD and depression.

Psychometric Characteristics of the Oxford Grief Memory Characteristics Scale and Its Relationship With Symptoms of ICD-11 and DSM-5-TR Prolonged Grief Disorder

Difficulties with loss-related memories are hypothesised to be an important feature of severe and enduring grief reactions according to clinical and theoretical models. However, to date, there are no self-report instruments that capture the different aspects of memory relevant to grieving and adaptation after bereavement over time. The Oxford Grief-Memory characteristics scale (OG-M) was developed using interviews with bereaved individuals and was subject to exploratory and confirmatory factor analyses in a community sample (N = 676). Results indicated the scale was unidimensional and demonstrated excellent psychometric properties. The impact of memory characteristics on symptoms of Prolonged Grief Disorder (PGD) according to both ICD-11 and DSM-5-TR criteria were investigated using cross-lagged structural equation modelling in a three-wave longitudinal sample (N = 275) at baseline and 6 and 12 months later. Results indicated that loss-related memory characteristics predicted future symptoms of PGD after controlling for autoregressions, and concurrent associations between symptoms and memory characteristics. Cross-lagged associations between memory characteristics and symptoms were significant in the first 6 months of follow-up. After that, memory characteristics predicted future symptoms, but not the other way round. Theoretical and clinical utility of the scale and its features are discussed.

A scoping research literature review to map the evidence on grief triggers

Grief is understandably severe in the first days, if not weeks or months, following the death of a beloved person. Unless the mourner develops complicated grief, which is prolonged severe and impactful grief, the initial acute grief lessens in severity over time, although waves of significant grief will still occur with grief triggers. A scoping research literature review was undertaken in early 2021 to determine how often grief triggers occur, what the most common grief triggers are, the impact of triggered grief, and what can be done (by those not diagnosed with complicated grief) to manage grief triggers and mitigate the effect of them. Nine academic library databases were searched for English-language research reports using the keywords "grief trigger(s)" and "research": CINAHL, Directory of Open Access (online) Journals, Humanities Index, JSTOR, Medline (Ovid), Periodicals Index Online, PsychArticles, Scopus, and Web of Science. Six research papers relevant for review were published in the last two decades, with some evidence gained on how often grief triggers occur, what constitutes a grief trigger, and the impact of grief triggers. Major gaps in evidence were revealed, despite grief triggers being identified as a major consideration for grief in general and for grief recovery specifically.

Prolonged grief and posttraumatic stress disorder following the loss of a significant other: An investigation of cognitive and behavioural differences

BACKGROUND

Cognitive behavioural correlates to bereavement-related mental health problems such a Prolonged Grief Disorder (PGD) and Posttraumatic Stress Disorder (PTSD) are of theoretical and clinical importance.

METHODS

Individuals bereaved at least six months (N = 647) completed measures of loss-related cognitions and behaviours (i.e., loss-related memory characteristics, negative appraisals, coping strategies, grief resilience, and perceived social disconnection) and measures of PGD and PTSD symptoms. Individuals were assigned to one of four groups depending on probable clinical diagnoses (No-PGD/PTSD, PTSD, PGD, PGD+PTSD).

RESULTS

Results indicated that higher loss-related memory characteristics and lower grief resilience increased the likelihood of a clinical problem. The PGD and PGD+PTSD groups reported significantly higher loss-related memory characteristics and appraisals compared to the PTSD group. Social disconnection increased the likelihood of comorbid PGD+PTSD in comparison to any other group.

CONCLUSIONS

Results indicate cognitive differences between loss-related cognitions, memory characteristics and coping strategies between PGD and PTSD, and points to distinct cognitive correlates to psychopathology following loss.